Specific issues in nutritional care
of HIV patients
NAUSEA, VOMITING, AND DIARRHEA.Nausea and
vomiting are common symptoms of HIV infection as
well as side effects of HAART. They can lead to long-
term damage to the esophagus and dental problems as
well as weight loss and inability to take needed medi-
cations. About 30% of patients develop nausea and
vomiting within 1 to 4 weeks following infection as
part of a condition called acute retroviral syndrome or
ARS, which resembles influenza or mononucleosis.
Most patients, however, develop nausea, vomiting,
and diarrhea later on in the course of the disease
as side effects of HAART or from opportunistic infec-
tions of the gastrointestinal system. Patients with
HIV infection are highly susceptible to such diseases
asgiardiasis, cryptosporidiosis, listeriosis,Campylo-
bacterinfections, andSalmonellainfections.
Treatment of nausea, vomiting, and diarrhea in
patients with HIV infections may require a number of
diagnostic tests and imaging studies as well as evalua-
tion of the patient’s medications in order to determine
the cause(s) of the symptoms.
LIPODYSTROPHY.Lipodystrophy is the medical
term for the redistribution of body fat that sometimes
occurs in patients with HIV infection as a result of
HAART, genetic factors, the length of time a person
has been HIV-positive, and the severity of the disease.
It is not completely understood as of the early 2000s
why antiretroviral drugs and other factors have this
effect. The patient may notice new deposits of fat at
the back of the neck (sometimes called ‘‘buffalo
humps’’) and around the abdomen. Conversely, fat
may be lost under the skin of the face, resulting in
sunken cheeks, or lost under the skin of the buttocks,
arms, or legs. Lipodystrophy is not necessarily associ-
ated with weight loss.
Lipodystrophy may be accompanied by other
changes in the patient’smetabolism, particularly insu-
lin resistance and higher levels of blood cholesterol
andtriglycerides. One recommendation nutritionists
often give to patients with lipodystrophy and meta-
bolic changes is to follow theMediterranean diet,
which is high in fiber-rich whole grains and vegetables
and low in saturatedfats. Another recommendation is
to maintain a schedule of regular physical exercise
(particularly weight training), which has been shown
to lower insulin resistance and decrease abdominal fat
deposits.
WASTING.Wasting refers to rapid unintentional
weight loss (usually defined as 5% of body weight over
a period of 6 months) combined with changes in thecomposition of body tissue. Specifically, the patient is
losing lean muscle tissue and replacing it with fat. The
patient’s outward appearance may not be a reliable
guide to wasting, particularly if he or she also has
lipodystrophy. Weight loss associated with wasting
may result from nausea and vomiting related to
opportunistic infections of the digestive tract as well
as from reactions to medication.
Nutrition is the first line of defense against wast-
ing. To help the patient maintain weight, nutritionists
recommend raising the daily calorie intake from 17–20
calories per pound of body weight (a guideline used for
patients whose weight has been stable) to 25 calories
per pound. Patients with wasting syndrome may
require as much as 3500 calories per day to maintain
their weight. Nutrient ratios should be 15–20%pro-
tein, 50–60%carbohydrates, and 25% fats to protect
the body’s muscle tissue. Patients who need more calo-
ries or protein may benefit from adding such supple-
ments as Ensure or Instant Breakfast to their daily
diet. In addition, weight training or other forms of
regular exercise help to maintain muscle tissue.
Other treatments for wasting include the use of
appetite stimulants to increase food intake and hor-
monal treatments to build lean muscle tissue, partic-
ularly in male patients.
MEDICATION INTERACTIONS.Most medications
used in HAART have the potential to cause nausea
and vomiting. Some antiretroviral medications should
be taken with food to minimize these side effects.
Digestive disturbances are the single most common
reason given by patients for discontinuing antiretrovi-
ral therapy. In some cases, switching to a different
combination of drugs helps to relieve nausea, vomit-
ing, or diarrhea.FunctionThe function of nutritional education and dietary
management in patients with HIV infection and AIDS
is to maintain the patient’s energy level and ability to
carry out normal activities of daily life; lower the risk
of opportunistic infections of the digestive system; and
minimize the side effects of HAART on the patient’s
ability to eat and enjoy food.BenefitsThe benefits of good nutritional care of patients
with HIV infection are prolonged survival, improved
quality of life, and fewer or less severe side effects from
medical treatment.AIDS/HIV infection